Caused when bacteria get into the urine (rarely viral or fungal) Bacteria usually from the bowel

E.coli causes 80-85%

Staphylococcus saprophyticus causes 10-15% Also Klebsiella, Proteus, Pseudomonas,

Enterobacter

Lower urinary tract is cystitis Upper urinary tract is pyelonephritis

Common bacterial infection in infants and children More frequently in girls, particularly around the age of toilet teaching Other risk factors:
Abnormality in structure or function of urinary tract Abnormal backward flow Vesicoureteral reflux (VUR)

A small percentage (0.33%) with recurrent UTI can develop chronic kidney disease as an adult

seen in 30-50% children with UTI Poor hygiene or toileting habits Use of irritants soap, bubble bath Family history of UTI

Often difficult to recognise due to non-specific symptoms and signs which can include:

In older children symptoms can be similar to those in adults:

Irritability Poor feeding Vomiting Fever

Pain, burning, stinging or urination Urgency and frequency Nocturia Wetting problems, even when toilet taught Abdominal or lower back pain Urine that is foul-smelling, cloudy or contains blood

Definitive diagnosis is not always possible in this age group as it is difficult to obtain a urine sample:
In babies-a plastic bag or absorbent pad to collect the

A positive urine culture is necessary for definitive diagnosis NICE only recommends imaging (ultrasound, DMSA, MCUG) for diagnosis in those less than 6 months, with an atypical UTI or with recurrent UTIs

urine In young children catch in a specimen bottle while they are passing urine If unable to obtain noninvasively, a catheter or suprapubic aspiration may be used (ultrasound first)

Normally hospitalisation is not necessary, but can occur if:

The child has high fever or looks very ill, or there is

a probable kidney infection The child is younger than 6 months old Bacteria from the infected urinary tract may have spread to the blood The child is dehydrated (has low levels of body fluids) or is vomiting and cannot take any fluids or medication by mouth

For infants and children 3 months or older:

Treat with oral antibiotics for 3 days. The choice of

antibiotics should be directed by locally developed multidisciplinary guidance. Trimethoprim, nitrofurantoin, cephalosporin or amoxicillin may be suitable The parents or carers should be advised to bring the infant or child for reassessment if the infant or child is still unwell after 2448 hours

For infants and children 3 months or older:

Consider referral to a paediatric specialist Treat with oral antibiotics for 710 days. The use

of an oral antibiotic with low resistance patterns is recommended, for example cephalosporin or coamoxiclav If oral antibiotics cannot be used, treat with an IV antibiotic such as cefotaxime or ceftriaxone for 2 4 days followed by oral antibiotics for a total duration of 10 days

Most children will recover fine, but some, especially those who are very young when they have their first infection or who have recurrent infections may need further testing to rule out urinary tract abnormalities

Prophylactic antibiotics should only be considered with recurrent UTI Asymptomatic bacteriuria should not be treated prophylactically Dysfunctional elimination syndromes and constipation should be addressed Children who have had a UTI should be encouraged to drink an adequate amount Children who have had a UTI should have ready access to clean toilets when required and should not be expected to delay voiding.

Common infection in children Most are treated with a short course of antibiotics If recurrent need further testing to see in underlying pathology Good hygiene and toilet training can help to prevent Should not cause urinary tract problems as an adult